Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Which patients, if any, do you offer transdermal estradiol as a method of ADT instead of LHRH agonists?
My default form of ADT remains a GnRH agonist or antagonist but estradiol transdermal patches are clearly effective and safe as an alternative option for men who either 1) have significant loss of bone density/osteoporosis, 2) have significant hot flashes with traditional ADT and wish to try an alte...
Are there any contraindications to Pluvicto therapy you personally use, given that there are none directly provided by the manufacturer?
In this situation, it is helpful to review the eligibility and exclusion criteria from the VISION protocol directly. These can be found at NCT03511664 (Sartor et al., PMID 34161051). Many of these patients have been heavily pretreated, including prior taxane therapy, so my main concern is that they ...
Do you use either memantine or hippocampal sparing technique to preserve cognitive function when giving whole brain radiotherapy?
Dr. @Dr. First Last and I put together the response below:We use memantine and hippocampal sparing technique for all brain metastasis patients who are planning to receive WBRT. This is based off the recently published phase III trial NRG CC001 that found hippocampal avoidance WBRT plus memantine res...
How would you approach the treatment of low grade, stage IA, triple negative apocrine adenocarcinoma of the breast in a female patient in her 70s?
I would not treat this the way I would a typical triple-negative breast cancer, since the risk of distant recurrence from occult metastatic disease is low. Assuming she had breast-conserving surgery, radiation, favoring partial breast, is reasonable. In terms of systemic therapy, if the cancer in th...
Is a stereotactic/ thin-slice MRI of the brain absolutely necessary to determine eligibility for hippocampal sparing whole brain radiation therapy?
The small size of the hippocampal dentate gyrus (3-4cc) can render it difficult to delineate and conformally avoid if both the brain MRI and the treatment-planning CT simulation are not obtained with thin-slice axial images (not exceeding 1.5mm on the MRI, not exceeding 2.5mm on the treatment-planni...
What are best practices for taking care of lung cancer patients during the COVID-19 pandemic?
This is a great question, and as always there is no one size fits all. For patients on active treatment for lung cancer such as chemoimmunotherapy, I continue to stress the importance of hand washing, social distancing, and to work on reducing wait times in the waiting room to limit exposure, etc. I...
What is your approach to locally advanced pancreatic cancer that has not progressed after neoadjuvant chemotherapy +/- chemoradiation but remains unresectable?
NRG GI011 was recently activated across the NCTN and will test ablative radiotherapy in this setting. This is a pragmatic and potentially practice-changing trial. Consider activating it at your center. Here is a nice summary from the PI @Dr. First Lasthttps://www.youtube.com/watch?v=MNsS7pHqZIk.
Which GI cancer patients do you use oral contrast in staging CT scans?
We do not use oral contrast for most of our patients and only offer oral contrast CT scans for patients we are concerned about perforation.
Would you offer re-irradiation LDRT for someone with osteoarthritis or tendinitis if symptoms recur?
I have not personally offered a patient a third round of LDRT and do not know of any data that shows efficacy. However, I might offer a third round if a particular patient got adequate results with the first two and there was some separation in time (perhaps >1 year) since the last round.
Would you use CT planning to treat a large keloid of the scalp post operatively?
Yes, we used a CT scanner for RT and HDR brachytherapy planning to treat keloids, depending on their location and complexity.